Provider Demographics
NPI:1487029005
Name:REZNIK, GABRIELLA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2926
Mailing Address - Country:US
Mailing Address - Phone:347-723-1934
Mailing Address - Fax:
Practice Address - Street 1:692 NEW HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1738
Practice Address - Country:US
Practice Address - Phone:347-723-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700841367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered